Chair of the Child & Adolescent Psychiatry working party for ICD-11
Sir Michael Rutter is the author of more than five hundred research papers, many of which are about autism. His work on Autism includes: early epidemiologic studies; studies involving a wide range of scientific techniques and disciplines, including DNA study and neuroimaging; links between research and practice; deprivation; the influence of families and schools; genetics; reading disorders; biological, social, protective and risk factors; interactions of biological and social factors; stress; longitudinal as well as epidemiologic studies, including childhood and adult experiences and conditions; continuity and discontinuity in normal and pathological development.
Gerardo Herrera, president of Adapta Foundation: You are chairing the Child & Adolescent Psychiatry working party for ICD-11, in charge of the ASD definition for that classification. From your personal point of view, do you foresee important differences between the DSM-V and ICD-11 definitions of ASD?
Sir Michael Rutter: At the moment there are important differences between proposals for DSM-5 and ICD-11. For the most part, there is broad agreement on the overall concepts but there are difficulties with respect to the details. That arises most especially because the DSM-5 starts with dealing with research criteria before considering the concepts and WHO does it the opposite way round. That is to say, the starting point with WHO is the clinical conceptualisation and the clinical criteria. At a later point, of course, research criteria have to be developed but that comes secondarily. In my view, that is the most appropriate way round.
GH: ASD is currently a behavior-defined disorder. How far are we from having biological markers of ASD that could be used to assist diagnosis?
MR: Over recent years there has been much discussion of biological markers and discussion too of whether they might either compliment or replace behavioural descriptions. The current state of play is that there are no biological markers that are usable clinically at present.
GH: There are some emerging technologies that facilitate objective measuring of human behavior (eyetracking, recording physiological responses, functional imaging). Do you believe that these or other similar technologies will play a role in supporting clinicians when diagnosing autism?
MR:There certainly are emerging technologies that potentially could play a role in supporting clinicians when diagnosing autism. The findings from Ami Klin on eye-tracking would be one example of those and the functional imaging findings (such as those from Mark Johnson's research group in London) have this potential. At the moment, however, they are research tools and there is some way to go before they can be used at an individual level clinically.
GH: Prevalence figures for ASD have shown a steady increase over the last 10 years. Do you put this increase down solely to changes in clinicians' sensitivity and awareness of autism?
MR: The increase in the prevalence figures for ASD are certainly due in part to improved clinical sensitivity and ascertainment and partly the broadening of the diagnostic concept. However, whether, in addition, there has been a true rise in incidence remains uncertain. I think it is important to keep an open mind on this because, if there has been a true rise, that would have implications for some non-genetic factor playing a role, probably a contributory role, in causation.
GH: How may the changes to DSM and ICD affect future prevalence estimates of ASD?
MR: The current proposals for DSM-5 would make a huge difference to prevalence estimates of ASD. That is because the field trials analyses undertaken by Fred Volkmar and his research group have shown that the majority of higher functioning cases (such as with Aspergers syndrome) would be excluded. There is a paper on this that is currently 'in press' in the Journal of the American Academy of Child and Adolescent Psychiatry. I hope that these findings will lead to a change of proposal for DSM-V.
GH: Innovative Technologies are being used in a wide range of forms to help people with ASD. Are there any particular technology approaches that you have found particularly exciting in the research field?
MR: I have no personal experience in using technologies as part of treatment. That is mainly because I have only a limited involvement in therapeutic work now. However, I am impressed by preliminary findings showing that robot technologies may be helpful. Robots are sufficiently different from living people for individuals with autism to respond to them in terms of an interesting new object rather than a living social interaction. On the other hand, the similarities between the best designed robots and what humans do in social interactions means that the learning involved in the individuals working with robots may generalise to how they deal with people. As far as I know, research findings on this are still at a rather preliminary stage but it does seem promising.
GH: What potential ways do you think technology could be used in research and practice in the future?
MR: The use of technologies with autism is still at an early stage and it is difficult to say quite how things will develop in the future. Nevertheless, the preliminary finding suggesting that imaging methods may show features that predict autism as early as 12-18 months do mean that, possibly, they could allow diagnosis at an earlier age than is currently feasible in most cases. Research in this area is definitely a priority but it remains to be seen how far this can be translated into something that is usable clinically. Much the same applies to the use of robots in treatment that I have mentioned already.
GH: Thank you very much for accepting our invitation to participate in ITASD Conference. It is a big honor to count on your collaboration. See you in Valencia on July 2012
|Last Updated on Thursday, 02 February 2012 23:07|